Five Things I Learned in the Operating Room that Revolutionized my Sewing

Posted on Jan 18, 2014 in Life of a Medical Student, Sewing | 1 comment

As a medical student, I’ve spent a lot of time in the operating room learning how to sew people back together, and took away a bunch of cool techniques to use in my sewing (fabric, not people) at home.

Now I’m no surgeon, but after the emergency department, the operating room is without a doubt my second favorite place in the hospital. I like it so much so that I did an acting internship on the trauma surgery service and I’m still spending some weekends volunteering with the service (much to the horror of emergency medicine residents, who seem to universally dread the 80 hour weeks and endless scalp-suturing). I have a profound respect for the attention to detail, fine work, and value placed on technique that these surgeons develop. Here are some of the things I learned from them (still done with substantially less finesse than they do it with). These techniques may not be new, and maybe they have sewing names that I don’t know, but they were new to me so I thought I’d share.

1. Closing holes (invisibly) with a running subcuticular suture

subcuticularThe subcuticular suture is a technique used in skin closure, done with absorbable sutures, which creates a cosmetically pleasing and virtually invisible seam. The basic idea is that the sew parallel to the skin, immediately below the surface. I used to use an overcast stitch to close gaps in pillows and things when you turn them right side out, but it’s virtually impossible to do it without being left with external evidence. By mimicking the subcuticular technique, my seams are virtually invisible now.

The way I do it is to take small bites right at the fold line where the seam need to be closed, in line with the direction of the seam, making sure not to pierce the outside of the seam. If you line up each new bite with the exit point of the previous stitch, when you pull the whole thing tight, it lines up perfectly and invisible. Tie a knot at the end, and as a surgeon would say, “bury the knot,” by simply passing the needle down through the seam and out again at a point a fair distance from the knot. Cut the string and the end disappears into your work.

Subq stitching

2. Stuffing small things with tweezers

wound packingYou often have to pack wounds with gauze post-operatively (or after draining an abscess in the emergency department), and we use a lot of this packing strip material to do it. Often, you’re putting it into a hole that is just a centimeter or so wide, but sometimes quite deep. To get it all the way in, we usually use a combination of forceps and cotton-tipped applicators.

It never occurred to me to use tweezers to stuff little things (like the tiny pillows I’m making for my miniature dorm), but I’ve started using them now because it allows me to get a lot of stuffing into a tiny hole, which means shorter distances that I need to oversew. (I don’t need to use a cotton tipped applicator to get it in deeper, because there are no squishy internal organs in my pillows that I can damage with my tweezers).

pillow stuffing

 3. How to hold scissors (I’m serious)

I never thought that my whole approach to holding scissors would be changed by my time in the OR, but it was! And honestly, this is one of the biggest revelations I had while I was there. Scissors in the OR are, surprisingly, often dull and crappy. This means that you inevitably suffer an embarrassing moment where you try to snip a thread, the scissors awkwardly jam the suture thread between the blades, and you look like a fool who didn’t learn to use scissors in the 1st grade.

But one scrub tech (the poor soul who is responsible of making sure none of us mess up the sterile field and that the surgeon has all of the instruments he needs before he knows he needs them), gave me a simple tip: Push against the top finger loop with your thumb and pull on the bottom one with your fingers. It makes the blades align with more force and lets you cut through thick string (like suture), even with a really dull blade.

scissors_reduced

4. Hemostats are the pliers, clamps, and extra hand of delicate work

This tip is all over the internet already, so I don’t feel a need to elaborate too much, but everyone should have a hemostat in their tool kit for sewing, or any other type of DIY really. In the OR, they go by all sorts of names – the Kelly Clamp, Mosquito, Kocher, Halsted, all sorts of others. But they all serve the same basic function – they hold really tightly onto thin things and lock into place. I have three types – one curved, one straight with a serrated jaw, and one straight with a smooth jaw. You can buy them for virtually no money at all on amazon. I’d also recommend buying a complete dissection kit (like this one). The scissors pictured above also came from my dissection kit, and they’re great for precision cutting.

hemostats_reduced

5. Using a loop and extra thread to tie a knot when the thread is too short

This was a technique I saw a surgeon use (after biting a resident’s head off for letting me cut a suture too short), and I saw it several times thereafter. In surgery, if you can’t tie a knot, you basically have to take the whole length of suture out and do it again, so being able to tie the knot even when someone messes up, is a good thing. This isn’t exactly the same as was done in the OR, but it’s the same basic idea: making a loop to put a longer string through, so that you can use that length to tie a knot on a really short string.

Knot Tying

1 Comment

  1. Nice to see someone else who has taken their medical training and applied it to other things :-) We did Frankenfruit too, and used car washing shammies (very realistic when wet). Your minis are amazing, and I’m glad you are in the Undersized Urbanite too!

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